Joe the Commenter: “What’s Wrong with Obamacare?”
As today marked the conclusion of oral arguments presented to the Supreme Court of the United States regarding President Obama’s deceitfully-named Patient Protection and Affordable Care Act (or “PPACA,” or “Obamacare”), I thought it would be appropriate to post an entry on the trending topic. Below you will find a comment that was posted in response to [one of the many] enjoyable health care write-up[s] on the Minnesota Free Market Institute (MNFMI) web page (now part of the Center of the American Experiment). The commenter, Joe Bruce, (or “Joe the Commenter”) offered a rebuttal to MNFMIs terse and versed analysis of the unconstitutionality of the “minimum coverage requirement” (otherwise known as the “individual mandate”) and shared his other perspectives on the broader legislation and state of the health care market in general. My rebuttal to Joe the Commenter follows his quoted text below.
The full article and original comment can be found here, but for the purpose of this entry I am only including Joe the Commenter’s flare-up, which includes many of usual suspects that show up to the crime scene of defending this historically over-reaching legislation, followed by my rebuttal/response to these typically-cited claims/requests (as my response is in comment form the style is appropriately more “conversational,” and unfortunately it was apparently too lengthy to actually be posted on MNFMIs webpage).
Joe Bruce says:
Auto insurance is required by law in every state but New Hampshire. That is government mandating us to buy something. Why is this ANY different than what Obamacare is doing? You could say that not everyone has to drive a car, but who besides people in lower Manhattan has a job and not a personal automobile? I think its crap to have to buy auto insurance, believe me, it’s way over priced and people rarely get to collect a claim and get any value back other than peace of mind when riding down the highway playing with a smarthphone like most of these slobs do on the road these days.
Do yourselves a favor, download [the bill] and look on pages 59, 106, 107, 108 and other such pages that when you type “exe” in the word finder, the program will find the word exempt and exemption, you’ll find all sorts of places where indivuiduals may be granted exemptions from this big scary government mandate. Everyone needs health insurance, but if you can’t afford it they aren’t going to throw you in jail or fine you.
Believe me, people that can afford it have insurance now, and will have insurance later. Are people going to drop insurance just out of political spite? No.
I make around 20k a year and I dont have any, and haven’t seen a doctor since I was 14. I could be dying of cancer right now at age 25 and would have no idea because I can’t afford to see a doctor.
Somebody please tell me what else is wrong with the Affordable Care Act?
Adam Tenet says:
I’d like to respond to your comment point-by-point, if you will, hopefully help shed some light on the concerns and address some of your specific claims/questions.
So to your first point, let me present a couple of the distinctions between government requiring people to buy auto insurance versus health insurance:
First, in the case of auto insurance it is the state governments who compel drivers to purchase auto insurance, not the federal government. The federal government does not have the constitutional authority to compel citizens of the states to purchase any good or service (nor should it!). My enumerated powers doctrine/10th Amendment knowledge isn’t quite where I’d like it to be yet, but generally speaking you especially don’t want the federal government, with whom you may have very limited representation (say if you reside in a low-populated state, for example), to be able to control you at will at the behest of the majority. Also, despite your claim that only those living in lower Manhattan could get buy without an automobile, you actually could get by a lot easier than you might think (e.g., think buses, taxi cabs, ride-share programs, bikes, walking trails, etc.) Additionally, I recall that certain of my friends did not drive at all during their college careers, but still held a job and got by just fine. It’s very possible to get by without driving. Also on this point, you say “its crap to have to buy auto insurance,” and I agree! But that really kills your seemingly analogical support of Obamacare. That is, if you think it is crap that you have to buy auto insurance, and you analogize having to buy auto insurance with having to buy health insurance, then you also must also think it’s crap to have to by health insurance, i.e., you think the individual mandate is crap (and you’d be right, it certainly is!). But I gathered from your comment that you are actually largely supportive of, or at least not opposed to, the Obamacare legislation so I guess I don’t follow your analogy. The bottom line here is that the federal government does not have the constitutional authority to compel citizens of the states to purchase any good or service.
Next I did what you asked and searched the PDF for “exempt.” Sure it does include exemptions, but if I, as an individual taxpayer, wanted to claim an exemption from the legislation I would surely have to hire an attorney (or team) and an accountant (or team) to help me make my case and fill out the appropriate paperwork. I just find it unfortunate that you, Joe Bruce, who agrees that it is crap to have to buy insurance, finds solace in the legislation since it somehow, through a labyrinth of legalese and technical jargon that Indiana Jones, JD could barely navigate, might exempt you from purchasing health insurance (and mind you that exemption may only be acceptable to the federal government if you convert to a certain religious belief or in some other way lie to meet an exemption qualification…seems like a far cry from freedom to me!).
Further, not everyone needs health insurance, it’s a personal decision. A healthy guy like yourself should probably only see a doc for nothing more than an annual physical, which would cost ~$150 out of pocket (and if that seems high you can thank CMS for below-market doc reimbursement rates and a difficult collection environment from non-payers). Heck, tack on a bout of strep you hypothetically contracted during the year and, including the throat culture and a dose of some generic antibiotics, you’re still only looking at roughly $250 out of pocket ($150 for the office visit, $50 for the throat culture, and $50 for the prescription antibiotics). So typical annual expenses for an uninsured, young, relatively healthy individual (such as yourself) could be about $250. That cost is still considerably less than what you would pay for insurance premiums for the same year (according to a 2009 AHIP study, the average annual insurance premiums for an individual policy in Minnesota is $2,978). Now of course that cost/benefit analysis is subject to each individual’s own risk tolerance and countless other factors, but speaking personally based on my actual experience I should have taken that risk! Between the ages of 18 and 28, I would have saved thousands of dollars if I would have just paid out of pocket for my care, having never suffered anything beyond a sore throat and a one-off kidney infection during that time period (thank you God)! Of course I would never have taken the risk being a generally cautious person, but it can be a totally reasonable decision to go without health insurance as a young, healthy individual, understanding of course that in the (rare) event something major did happen you would have to pay the docs for their services. The point here is you should have a choice, it is your body, your health, and ultimately your responsibility. To claim rights to someone else’s services (i.e., “free health care”) is akin to theft.
Next, I agree that employers would not drop insurance out of political spite, but they would out of economic analysis! With the passage of Obamacare there will be new insurance premium subsidies for those who earn up to 400% of the federal poverty level ($43,320 for individuals, or $88,200 for a family of four according to a 2010 Kaiser Health News article), vast Medicaid expansion, and the prohibition of coverage denial for preexisting conditions, or said another way, “the premium-spiking injection of the moral hazard into the vein of societal decision-making,” (i.e., healthy dudes like yourself could technically wait until they blow out their knee or become very ill and then sign up for a policy without being turned down and could still get the medical costs paid). In addition to those facts, Obamacare will fine employers who do not offer employee coverage but the fine they impose will surely be a fraction of what the employer had previously paid in member premiums (likely even after considering a salary bump to further help offset the potential cost employees may incur to purchase their own policies). So now employers will have to make a decision: drop employee coverage, pay the fine and perhaps even give raises so employees can purchase their own plans, which would likely still be cheaper on the net to the employer depending on facts and cicurmstances (remember, the employees will qualify for new premium subsidies, Medicaid services, and/or will practice the moral hazard of waiting to purchase a policy), or maintain existing coverage. For employers who run that analysis and find that they will save on the net while still resting at ease knowing their employees can access insurance through exchanges, expanded Medicaid services, or by playing the moral hazard card, they may indeed decide to drop coverage! Despite the fact that the CBO does not estimate this becoming a significant trend, in the event it does the cost of this bill will skyrocket which would be severely detrimental to the fiscal health of the federal government (as if it weren’t already on its death bed!). But generally speaking, that is why employers would drop their existing coverage, not “out of political spite” but out of economic reality.
Further, you can totally afford to see a doctor! Despite what you hear or see, a simple visit to the doc at your age would not likely run any more than $150, seriously, check some local rates. Of the ~$20K/year you take home, it would surely be one of the wisest ways you could spend less than 1% of your income (i.e., on your health). Going forward too, you should really look into grabbing an individual insurance policy for yourself. A young/healthy guy like yourself could probably find a decent policy for around $1,500 (or less!) per year, and be sure to check with your employer to see if they offer any plans. Of course the health care market still has a LONG LONG way to go to be consumer-friendly but in the meantime general non-surgical/non-hospital services are much more affordable than you may think. And don’t get me wrong here, the cost of health care is indeed the most significant issue at play as it is always outpacing inflation with no signs of slowing down, but of course the Obamacare legislation does nothing to legitimately address the underlying costs of care, surprise surprise! However, even with the current out-of-control cost trend, general office visits for someone in your situation are still relatively affordable especially if you shop around, though I would strongly recommend looking into a major medical policy at a minimum just to be on the safe side.
I encourage you to go ahead and schedule a physical with a local doctor. And before you do, call around and see what they charge, and then you can do a little research on the individual docs through websites and decide what you are willing to pay for what kind of experience/specialties/etc. (a little market discipline would be a very good thing for the health care market). And if you have something that you think may be a cause for concern as it relates to potential cancer/tumors as you noted above, tell the doc about that at your visit and he/she can help you discern if it is something you should be worried about (but really apart from either an obvious lump or other very prevalent physical symptoms, cancer diagnoses at your age are few and far between, and even without knowing you personally I hope it’s not something you ever have to experience). But before you go emotion-trolling with such heavy bait, I suggest doing more research before making cries of cancer to try and win people’s opinions in favore of such ill-advised legislation.
Lastly, in addition to the examples noted throughout the discussion above, consider the following quick points in response to your request to learn “what else is wrong with [Obamacare]?”:
- It does nothing to help curb the rising costs of health care (in fact it will really only result in higher premiums, in part due to some of the examples cited above);
- It is projected to cost well in excess of $1 trillion (that’s “trillion” with a “T”! In fact, per the latest CBO report issued March, 2012 it is actually $1.8 TRILLION gross, netted with ~$500 billion of projected related tax receipts and penalty payments that total comes down to a still incomprehensible $1.3 TRILLION…it’s not like that $500 billion in taxes/penalties would have gone to good use in the hands of the private citizens who earned it anyway…might as well steal it from them to make our health care bill easier to swallow!);
- It will significantly burden state budgets with rampant (unconstitutional!) Medicaid expansion;
- The ratio of the complexity of the legislation to the time it spent in congress meant it was necessarily not thoroughly debated/analyzed (i.e., a bill that adds tons of red tape to a sector representing nearly 20% of our nation’s GDP deserves much more scrutiny and debate and analysis, a preferred approach would be to examine the bill BEFORE it is passed into law, despite howls from then House Majority Leader Pelosi to the contrary); and
- It has taken away choice for private institutions who do not want to pay for/be required to cover certain birth control measures.
Additional examples of “what else is wrong with [Obamacare]?” as well as specific citations are available upon request.